The purpose of this study is (1) to complete the analysis of the data collected under the current grant and (2) to collect comparative data on quality of life of patients being treated by dialysis rather than kidney transplantation for terminal kidney disease. In order to investigate the long-term social-psychological impact of kidney transplantation, a cohort of patients who received a kidney transplant between 1970-3 has been followed for several years. One-hundred and forty-eight surviving patients have been interviewed 5-9 years post-transplant (1978-80) as well as pre-transplant, one month post-transplant and one year post-transplant. The major quantitative measures focus on their quality of life, self-image, and rehabilitation. At similar times 133 relatives who donated kidneys to these recipients were interviewed, as have a control group of 65 family members who did not volunteer to donate (non-donors). In analyzing these collected data, we propose to discover to what extent and for what subgroups the initial high-levels of adjustment persist into the 5-9 year post-transplant period. First of all, this study should help to evaluate the social-psychological and ethical cost of a very expensive new technology. Are the patients experiencing a high enough quality of life to justify the cost? Many centers are reluctant to transplant children due to a presumed low level of rehabilitation. In fact, what is their long-term level of adjustment? Is the longterm effect upon the related donors benign enough to recommend their continued use or does careful measurement suggest ethical and psychological contra-indications to their use? How do long-term dialysis patients, who do not require the use of donor organs, compare in quality of life to transplant patients? What types of dialysis patients, transplant patients, and donors are particularly vulnerable and in need of extra support? Secondly, the analysis of these data should contribute theoretical insights to the investigation of the long-term consequences of crisis management for the self-image; the analysis of the impact of health status upon psychological adjustment; the study of family roles in illness and in help-giving; the analysis of interpersonal altruism and gift-exchange; the exploration of the consequences of conflict and communication block ages for family cohesion over the long-run; and the identification of factors affecting the donor's response to his own altruism and sacrifice.